Society of Cardiovascular Anesthesiologists

President's Message

Our Credibility is at Stake

The development of intraoperative echocardiography has been an enormous blessing for cardiothoracic anesthes-iologists. From mere facilitators of disease management, we have become active participants in the planning, performance, and evaluation of cardiac surgical interventions. The cardiac surgeons have grown accustomed to the skillful interpretation of echocardiograms by the anesthesiologists. They rely upon us to provide them with accurate information on the patients' cardiac lesions and function. After carrying out the surgery, they expect us to evaluate the quality and completeness of their intervention. In acquiring the skills necessary to become proficient echocardiographers, we have dramatically broadened the scope of cardiothoracic anesthesiology and have added significant value to the services that we provide.

Yet, with such new activities have also come some new responsibilities. The 1996 ASA/SCA Practice Guidelines for Perioperative Transesophageal Echo-cardiography included lists of basic and advanced training objectives.¹ Under "Basic Training", the last technical skill on the list was: "Ability to communicate the results of a TEE examination to the patient and to other health care professionals and to summarize these results in the medical record". The reasons for including this objective were fairly obvious to the members of the task force. Since the information obtained during an intraoperative echocardiography exam is used to influence disease management, it belongs in the patient's permanent medical record. The patient and other health care professionals should be able to access it readily for future reference.

However, when I talk with colleagues, it appears that the clear documentation of intraoperative echo information is far from being a standard practice. Comments have included: "I perform TEE on all my patients, but I never record anything", "Since the hospital cut the budget for videotapes we have stopped recording our TEE exams", "My anesthesia colleagues are very proficient at intraoperative TEE, but as the referring cardiologist I can never find a note in the chart", etc. Such approach does not serve our specialty well. In every other specialty, it is routine to document clearly the findings of investigations. To retain our credibility, we MUST adopt a similar practice.

To facilitate such activity, the SCA in collaboration with American Society of Echocardiography (ASE), has taken some proactive steps. In the October issues of Anesthesia & Analgesia and of the Journal of the American Society of Echocardiography, you will find the simultaneous publication of a document entitled: "ASE/SCA Guidelines for Performing a Comprehensive Intraoperative Multiplane Transesophageal Echocardiography Examination". In addition to providing a logical, stepwise approach to the performance of an intraoperative echo exam, the document's principal value may be that it defines a standard nomenclature for TEE echo views and cardiac structures.

To further facilitate the reporting of intraoperative findings, the SCA and ASE have jointly appointed a task force to develop a "Standard Report of Intraoperative TEE Findings". The Chair of the task force is Steven Konstadt, M.D. and it is expected that within a few months, the task force will present its proposal to the Board of Directors of both societies. Clearly, SCA is fully committed to help its members practice TEE at the highest standard. I believe that our patients and our colleagues deserve nothing less.

If you have comments or suggestions on these issues, please feel free to communicate them to me at sca@societyhq.com. After editorial review by the Newsletter Committee, they will be published. One of my hopes is that the SCA Newsletter will develop into a forum for active discussion on topics that interest us all.

Daniel M. Thys, M.D.
President, SCA

1. Practice Guidelines for Perioperative Transesophageal Echocardiography. A report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echo-cardiography. Anesthesiology 1996; 84: 986-1006